To investigate the effects of prostaglandin E1(PGX1) in prevention of proliferative scar formation, we cultured fibroblasts of normal skin (NS), hypertrophic scar (HS) and keloid (KL) tissues obtained from patients. We have compared type I collagenase production of cultured fibroblasts from normal skin, hypertrophic scar, and keloid tissues under various concentrations of PGE1. Our results demonstrate that type I collagenase production was significantly increased after addition of PGE1 in HS and KL, but not NS. Type I collagenase production of HS and KL fibroblasts were increased similarly in 10M and 10M of PGE1 and maximally increased in the concentration of 10M. This promotive effects of PGE1 on the production of type I collagenase was larger in KL than in HS. These results also suggest that PGE1 may play the promotive effects on type I collagenase production in dose-dependent manner. PGE1 may have a role in the prevention of hypertrophic scar and keloid by enhancing the production of type I collagenase of HS and KL fibroblasts. The promotive effects of PGE1 on type I collagenase production was variable depending on its concentration, and its effects was maximum in certain optimal condition. The maximally effective concentration of PGE1 in the prevention of proliferative scar formation should be searched in further investigations for clinical use.
Alprostadil ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagenases* ; Fibroblasts* ; Humans ; Keloid* ; RNA, Messenger* ; Skin

BACKGROUND: Recent evidences suggest that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Intrathecal endothelin-1 (ET-1) is known to have antinociceptive effect. The purpose of this experiment was to determine whether intrathecal ET-1 may influence the minimum alveolar concentration (MAC) of isoflurane in rats and access the role of the spinal cord as the sites of anesthetic action in blocking somatic responsiveness. METHODS: In Sprague-Dawley rats fitted with an indwelling intrathecal catheter, we determined the MAC of isoflurane using a tail-clamp technique as a painful stimulus, combined with end-tidal anesthetic sampling. In experiment 1, the control MAC was determined and changes of control MAC were observed after intrathecal ET-1 (4x10-2 nmol, 4x10-3 nmol) administration. In experiment 2, we observed the effects of L or N type Ca++ channel blocker such as verapamil (50 g) or W-conotoxin (0.5 g) on the MAC after measurement of the control MAC. In experiment 3, after measurement of the control MAC, ET-1 (10-2 nmol) was administered intrathecally and the MAC was determined again. Next, intrathecal verapamil (50 g) or W-conotoxin (0.5 g) was injected. After that, the MAC was determined again. RESULTS: In experiment 1, ET-1 decreased the MAC of isoflurane and its effect was sustained over 2 hours. In experiment 2, the MAC, determined following administration of verapamil or W-conotoxin, was not different from that of the control. In experiment 3, the MAC was decreased after ET-1 administration and then increased following injection of verapamil or W-conotoxin. CONCLUSIONS: These results suggested that ET-1, in relation to calcium, might play an important role in determining the MAC of isoflurane in the spinal cord.
Animals ; Calcium ; Catheters ; Endothelin-1* ; Isoflurane* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Verapamil

Although sacrococcygeal mass is rare and usually found in infants or children, adolescent or adult patients with protruding mass in sacrococcygeal region occasionally come to us simply for a cosmetic problem. In this situation, even though there is no definite neurological deficit, it should be evaluated whether or not the underlying bony pathology or dural defect exists. Few cases about the sacrococcygeal mass have been reported in adults. We reviewed our cases including preoperative evaluation methods and postoperative diagnosis. From March, 1993 to February, 1997, we experienced 6 adult patients with sacrococcygeal mass and no neurological abnormality. Preoperative evaluation were made by plain X-ray, myelogram, computed tomography(CT), and magnetic resonance imaging (MRI), as needed. Postoperative diagnoses were 2 meningoceles, 2 lipomyelomeningoceles, 1 desmoid tumor, and 1 teratoma. From our experiences, CT or MRI is essential to evaluate the sacrococcygeal mass preoperatively. These methods can visualize the precise anatomic location and extent of the mass, its relation to the spinal cord, and associated bony abnormalities. MRI is superior to CT, especially in defining the nature of the mass and involvement of the spinal cord. Conclusively, even a simple mass in the sacrococcygeal region in adults needs MRI or CT evaluation, and MRI is the most valuable method of evaluating the mass preoperatively and provides important information to establish a treatment plan.
Adolescent ; Adult* ; Child ; Diagnosis ; Fibromatosis, Aggressive ; Humans ; Infant ; Magnetic Resonance Imaging ; Meningocele ; Pathology ; Sacrococcygeal Region* ; Spinal Cord ; Teratoma

Healing is an intricate, interdependent process that involves complex interactions between cells, the microcellular environment, biochemical mediators and extracellular matrix molecules. The goals of wound healing are to minimize bloods loss, to replace any defect with new tissue, and to restore an intact epithelial barrier as rapidly as possible. The rate of wound healing is limited by the available vascular supply and the rate of formation of new capillaries and matrix molecules, which are heavily influenced by locally-acting growth factors that affect proliferation, angiogenesis, chemotaxis, gene expression, proteinases, and protein production. We present a new method for wound control and treatment, the V.A.C (vacuum-assisted closure) technique. It places open-cell foam dressing into the wound cavity and applies subatmospheric pressure. The application of subatmospheric pressure accelerates the rate of wound healing by the foollowing two mechanisms: 1. Removal of excessive interstitial fluids, which decrease localized edema, reduce concentration of inhibitory factors, and increase local blood flow. 2. Transmission of mechanical forces to surrounding tissues with resultant deformation of the extracellular matrix and cells, which then increase protein and matrix synthesis as well as cell proliferation. We applied it to 17 patients: 1 Livedo vasculitis, 1 burned by flame 3 pressure sores, 1 extravasation injury, 1 wound infection, 2 wound disruption, and 8 diabetes mellitus feet. In the end, most of the remaining wounds were treated with a simple split-thickness skin graft and the results were encouraging. We concluded that the V.A.C technique may be an effective substitute to help promote wound healing. It could be especially helpful in chronic complicated wounds in aging or debilitated patients who can not tolerate aggressive surgical procedures.
Aging ; Bandages ; Burns ; Capillaries ; Cell Proliferation ; Chemotaxis ; Diabetes Mellitus ; Edema ; Extracellular Fluid ; Extracellular Matrix ; Foot ; Gene Expression ; Humans ; Intercellular Signaling Peptides and Proteins ; Peptide Hydrolases ; Pressure Ulcer ; Skin ; Transplants ; Vasculitis ; Wound Healing* ; Wound Infection ; Wounds and Injuries*

PURPOSE: This study was performed to describe the ultrastructure of stromal nerve fibers in central, mid-peripheral, and peripheral parts of the human cornea by flat serial corneal section. METHODS: Seven samples from fresh normal cornea, derived from eyes with retinoblastoma and eyes from eye bank, were processed for transmission electron microscopic examinations. Flat serial sections reaching from mid-epithelium to the anterior stroma were observed. RESULTS: The myelinated and unmyelinated nerve fibers are alternately arranged and run parallel to the stromal collagen fibers at the periphery of the cornea. The main difference between the limbal and the central cornea is the presence of myelinated nerve fibers in the anterior peripheral stroma. The diameter of the unmyelinated nerve fiber measures between 0.25 and 0.63 micrometer in size. The corneal nerve fibers contain vesicles, mitochondria, and glycogen particles. The peripheral nerve fibers contain both clear and dense vesicles. The nerve fiber is separated by an interval of 0.3 micrometer from the cytoplasmic wall of keratocyte at the center of the cornea. CONCLUSIONS: The majority of the corneal nerve fibers can be classified as C-fibers due to their size. The presence of both clear and dense vesicles within the cytoplasm of the periphery of the cornea suggest that a small portion in the peripheral corneal nerve may be originated from the sympathetic nervous system. A close vicinity between the nerve fibers and keratocyte supports that nerve fibers might modulate the release of growth factors in the regulation of stromal and epithelial metabolism.
Collagen ; Cornea ; Cytoplasm ; Eye Banks ; Glycogen ; Humans ; Intercellular Signaling Peptides and Proteins ; Metabolism ; Mitochondria ; Myelin Sheath ; Nerve Fibers ; Nerve Fibers, Myelinated ; Nerve Fibers, Unmyelinated ; Peripheral Nerves ; Retinoblastoma ; Sympathetic Nervous System

No abstract available.
Mitral Valve*

Proliferative scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the biology and effective therapy of these entities. Consequently we created an accurate reproductive animal model to systematically study them. Human proliferative scars were explanted into flaps based on isolated vascular pedicles in congenitally rats. We compared the procollagen type III peptide levels of proliferative scar tissue before and after explanting. The procollagen type III peptide levels of explanted proliferative scar tissue remained increased as before explanting. Histological analysis of the explanted proliferative scar tissue revealed that all explants retained their original histotypic character even after 1 year. We could also retain the volume of implanted proliferative scar for 1 year and studied in vitro cellular proliferation. Fibroblast cultures from explanted scars demonstrated less aggressive growth characteristic than those from original surgical specimens. The advantages of this animal model are as follows: 1. The explants retain their histotypical character for a long period. 2. Placement of the explants outside the dorsum of a nude rat makes serial observation and measurement easier. 3. Agents under test can be injected into the explants through a catheter inserted into a single pedicle of island flap without the possibility of spreading systematically.
Animals* ; Biology ; Catheters ; Cell Proliferation ; Cicatrix* ; Cicatrix, Hypertrophic ; Collagen Type III ; Fibroblasts ; Humans ; Keloid ; Models, Animal* ; Rats ; Rats, Nude

No abstract available.
Animals ; Linoleic Acid* ; Macrophages, Peritoneal* ; Mice*

BACKGROUND: A decrease in mean arterial pressure (MAP) often accompanies aortic declamping during open heart surgery (OHS). But, there are no many reports to evaluate the extent of the decrease in MAP following the aortic declamping during OHS. METHOD: Twenty nine patients undergoing OHS, 17 patients for repair of cushion defect and 12 patients for valve replacement were evaluated. Anesthesia was provided by fentanyl (30 g/kg bolus followd by 0.3 ug/kg/min infusion) and intermittent inhalation of N2O-Isoflurane. An indwelling radial artery catheter was used to measure MAP. Systemic vascular resistance (SVR) was calculated using the formula. Measurements were made just before aortic declamping (control), and 1,3,5,7 and 10 minutes after declamping. RESULTS: MAP and SVR were decreased significantly until 7 minutes after aortic declamping compared to those of control value, and have a significant difference in decrease pattern of MAP following time interval after declamping between the patients for repair of cushion defect and the patient for valve replacement. The extent of decrease in MAP and/or SVR showed no significant relationship with difference the duration of bypass, patients body temperature and age. CONCLUSION: The results of this study indicated that there is a significant decrease in MAP and SVR after aortic declamping and it persists for about 7 minutes, without significant relation with bypass time, body temperaure and age.
Anesthesia ; Arterial Pressure ; Blood Pressure* ; Body Temperature ; Catheters ; Fentanyl ; Heart* ; Humans ; Hypotension ; Inhalation ; Radial Artery ; Thoracic Surgery* ; Thoracotomy ; Vascular Resistance

Livedo vasculitis is thought to be a thrombogenic disorder that is related to the autoimmune disease. It clinically shows purplish mottling and recurrent painful ulcers in the lower extremities, leaving atrophie blanche after healing of the ulcers. Histopathologic finding are thrombotic occlusion in the mid-dermal vessels without necrotizing vasculitis. The therapeutic approach has largely been made by the use of drugs that stimulate endogenous fibrinolytic activitiy, that inhibit thrombus formation, or that cause vasodilation, but surgical intervention by excision and skin graftion has rarely been reported as a primary treatment.In our experience, two patients with livedo vasculitis, who had been unresponsive to various medications, were treated with wide excision and several times of skin grafting. And they experienced complete healing without recurrence.
Autoimmune Diseases ; Humans ; Lower Extremity ; Recurrence ; Skin ; Skin Transplantation ; Thrombosis ; Ulcer ; Vasculitis* ; Vasodilation